T2DM With Severe Insulin Resistance: A Case Report

Insulin resistance (IR) means that the biological effect of the insulin is lower than expected normal level or patients need more than the normal amount of insulin dose to meet the normal physiological effect, which shows reduced sensitivity and responsiveness of target tissues(liver, muscle and adipose tissue). This paper reports a rare case of T2DM with severe insulin resistance. Though the patient was treated with 300-600U of insulin per day, he showed poor control of blood glucose level until he was treated with intravenous pump maintenance therapy with the insulin analogue lispro. This paper will discuss the possible mechanism of IR through biological signal conduction pathway, analyze the most possible reason in this case: insulin autoantibody and other aggravating factors:fat,infection,hyperglycemia and hypercoagulabale state and so on. We analyze the effect of drugs used in this case such asα-glucosidase inhibitors, thiazolidinediones, glucocorticoid and insulin analogue. Intravenous pump maintenance therapy with the insulin analogue is the first time reported. At last, domestic and international progress in the treatment of severe insulin resistance is reviewed.